Difference in Infarct Volume and Initial Clinical Severity between Stroke Patient with Patent Foramen Ovale and Atrial Fibrillation / 대한뇌졸중학회지

BACKGROUND: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. METHODS: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO. RESULTS: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history. CONCLUSION: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.

Statin-associated Myasthenia Gravis

No abstract available.

Effect of Physical Disability on Instrumental Activities of Daily Living in Alzheimer's Disease, Amnestic Mild Cognitive Impairment (MCI), and Vascular Dementia and Vascular MCI of Subcortical Type

BACKGROUND: Physical disability may result in some impairment of the score for Instrumental Activities of Daily Living (IADL). The aim of this study was to evaluate the effect of physical disability on IADL in patients with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), subcortical vascular dementia (SVD), and vascular mild cognitive impairment of the subcortical type (svMCI). METHODS: Fifty-six patients with AD, 30 with SVD, 27 with aMCI, and 21 with svMCI were recruited consecutively from a memory clinic. Informants for the subjects completed a Korean version of the IADL (K-IADL). In addition, the informants were asked to choose the cause of each dependent activity of K-IADL from the following: cognitive impairment, physical disability, or both. The cause of the physical disability was defined as being focal neurologic symptoms, other physical disease, or both. RESULTS: Compared to AD patients, SVD patients had higher K-IADL scores [2.02+/-0.80 (mean+/-SD) vs. 1.45+/-0.90, p<0.01] and focal neurologic signs (FNS; 8.0+/-5.8 vs. 0.0+/-0.0, p<0.001), and lower Barthel Index scores (14.7+/-5.1 vs. 19.6+/-1.2, p<0.001). Patients with svMCI had higher FNS (3.8+/-4.5 vs. 0.0+/-0.0, p<0.001) compared to those with aMCI. The most common cause of dependency of activities in K-IADL was cognitive impairment in AD, aMCI, and svMCI patients, and the combined effect of cognitive impairment and physical disability in those with SVD. The cause of physical disability was FNS in 96% of SVD patients and in all patients with svMCI. CONCLUSIONS: The effects of FNS as well as cognitive impairment should be considered when measuring the IADL of the patients with SVD or svMCI.

Impact of Obstructive Sleep Apnea on Carotid Intima-Media Thickness

BACKGROUND: Obstructive sleep apnea (OSA) is known to be an independent risk for cardiovascular diseases. The carotid intima.media thickness (IMT) is a surrogate marker of subclinical atherosclerosis. The aim of this study was to measure the carotid IMT in subjects with or without OSA and quantify its correlation with OSA severity. METHODS: Subjects were categorized into OSA and non-OSA groups based on polysomnography findings. The carotid IMT was considered a marker of atherosclerosis. The independent relationship between carotid IMT and OSA severity was analyzed using multiple linear regression. The presumed confounders were age, sex, body mass index, blood pressure, blood lipid and glucose profiles, smoking and alcohol drinking statuses, medications, being overweight, and having hypertension, diabetes mellitus, or hyperlipidemia. RESULTS: The carotid IMT was larger in OSA subjects (n=82, 0.620+/-0.096 mm [mean+/-SD]) than in non-OSA subjects (n=22, 0.551+/-0.078 mm; p=0.006), and was independently correlated with OSA severity (p<0.001). However, it was not affected by any of the other variables investigated. CONCLUSIONS: Subjects with OSA showed an increased IMT, with the thickness being correlated with the OSA severity. This finding suggests that accelerated atherosclerosis in OSA is the mechanism linking OSA and future cardiovascular events.

Gastric Perforation due to Mucormycosis in a Patient with Diabetic Ketoacidosis and Chronic Pancreatitis

Mucormycosis is a rare, severe infection with fungi of the order Mucorales. It is usually found in immunocompromised patients with diabetic ketoacidosis, glucocorticosteroid use, neutropenia in the setting of malignancy, and burns. Rhinocerebral disease is the most common form of mucormycosis. Other major symptoms are pulmonary, cutaneous, gastrointestinal, and systemic dissemination. Successful treatment requires removal of the underlying risk factor, antifungal therapy with amphotericin B, and aggressive surgery. We present a case of gastric perforation due to mucormycosis with diabetic ketoacidosis and chronic pancreatitis, with a review of the literature.

Deep Vein Thrombosis after Surgery for Gastrointestinal Cancer: Incidence and Correlation with Risk Factors

PURPOSE: Deep vein thrombosis (DVT) is recognized as a common complication in surgical patients in western countries, and especially for high risk patients. However there is little informations on the incidence and risk factors of DVT after gastrointestinal cancer surgery in Korea. The aim of this study is to evaluate the incidence and risk factors of DVT after gastrointestinal cancer surgery that is performed without antithrombotic prophylaxis. METHOD: From August 2003 to February 2004, 107 patients who underwent gastrointestinal cancer surgery were evaluated prospectively. Hypercoagulability studies were done before the operation or before any blood transfusion, and the other clinical risk factors were also examined. All the patients were examined between the 5th and 10th postoperative day with duplex ultrasonographic assessment of both lower extremities. RESULT: DVT was found in 8 patients (7.5%) and two patients had symptomatic DVT. Five patients showed thrombi in there calf veins, two patients in the popliteal vein, and one patient in the iliac vein. The DVT group showed a significantly higher incidence of hyperhomocysteinemia than non-DVT group. There was no statistically significant difference between the DVT and non-DVT group according to other risk factors. CONCLUSION: The incidence of DVT after intra-abdominal cancer surgery in Koreans is significantly lower than for the patients in western countries. Considering the lower rate of proximal DVT, routine prophylaxis for DVT appears to be unwarranted in Koreans before and after intra-abdominal cancer surgery. Finally we did not identify a correlation between DVT and the so-call risk factors except for hyperhomocysteinemia. It would be interesting to perform further studies to clarify the association between hyperhomocysteinemia and DVT in cancer patients.

Effect of orthodontic force on the amount of tooth movement and root resorption in rat / 대한치과교정학회지

This study was undertaken to investigate the relation between orthodontic force magnitude and the amount of tooth movement. And more light force application for reducing root resorption. Twenty-four rats were divided into three experimental groups(A, B, C) based on force magnitude and application method. Springs of 50g force were applied to A group, spring of 100g force were applied to B group and springs of 25g force were applied to C group initially, and after 4 days springs of C group were changed to springs of 50g force. Two kinds of sentalloy(R) (GAC U.S.A) closed coil spring, 50g and 100g, were used. And we made 25g springs by heat treatment process of 50g spring. Each spring was inserted between the maxillary central incisor and the maxillary left first molar. Amounts of tooth movement were measured everyday by digital caliper(Digimatic(R) , Mitutoyo, Japan) under inhalation anesthesia for 15 days, all rats were sacrificed and histological sample were obtained with Hematoxyline-Eosin stan and Masson's trichrome stain. Following conclusion were made : 1. Group B showed the mean cumulative tooth movement of 2.19+/-0.41mm at 15th day, which was greatest among three groups, followed by group C(2.06+/-0101mm), group A(1.90+/-0.49mm) respectively. However, there was no statistically difference among three groups. 2. All groups showed general tooth movement pattern and A, B, C group finished lag phase at 9th, 8th, 7th day, but three was no statistical significance. 3. Group A, B, C showed root resorption and especially group B showed the most severe root resorption and group C showed milder root resorpting than other groups. According to the above results, large initial force with the development of a fairly widespread hyalinized zone may cause severe root resorption, so initial force should be applied lightly to reduce hyalinized area and eventually root resorption and then increased force will induce efficient tooth movement.